Why cannabis edibles are worse than smoking
Popped after pudding at middle-class dinner parties or even nibbled on for a night on the sofa, edibles have become the socially acceptable face of cannabis consumption, particularly in gummy form. And the appetite for them shows no signs of being sated. Around one in 14 UK adults has tried edible types of cannabis, the most-used drug in England and Wales since records began in 1995, with the black market for the drug now worth an estimated £2.6 billion each year.
Yet the latest research may make those who casually pair them with wine want to rethink. A study from the University of California, San Francisco (UCSF) has for the first time shown that the heart health risks caused by these brightly coloured gummies are aligned with those suffered by cigarette smokers – and worse than those who actually smoke cannabis.
Participants in the study who consumed edibles three times a week saw their vascular function fall by around half; while their risk of premature heart disease was increased, too. Other side effects can include spikes in blood pressure, depression and anxiety, among many others.
The results are particularly concerning given the rise in people consuming cannabis in non-smokable forms, such as edibles, which has almost doubled in the past eight years, according to the US Centers for Disease Control and Prevention. (Their report last year found that this applied to 41.6 per cent of users, compared to 24.5 per cent in 2016).
UK police forces have warned that the gummies are often packaged as sweets and doled out to young people. There has also been a 'significant increase' in hospitalisations for children under-six due to inadvertently consuming their parents' supply and mistaking them for normal sweeties, according to research published in Pediatrics, with almost 90 per cent of cases occurring within the home.
'The rise in cannabis edible use is something I've increasingly noticed, particularly over the last couple of years,' says GP Dr Deepali Misra-Sharp – and 'it's not limited to younger adults either. I've seen growing interest among midlife and older patients, especially those managing chronic pain, insomnia, or anxiety,' she explains. 'Many are drawn to edibles because they're seen as more discreet and 'safer' than smoking cannabis — but that assumption doesn't always hold up.'
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What are cannabis edibles?
How do edibles affect the body?
How do edibles affect the brain?
What exactly are cannabis edibles?
Edible cannabis products vary enormously, both in form and content. Common types are gummies (often shaped like teddy bears or worms), along with cakes, crisps and brownies.
Some contain CBD (or cannabidiol), the chemical compound extracted from the cannabis plant that does not trigger a psychoactive response or create a 'high.' (Such products are legal in the UK, provided they contain less than 0.2 per cent THC.)
More commonly, edibles are laced with THC, or tetrahydrocannabinol – the psychoactive component of cannabis that is illegal in the UK, which carries the greater health risks.
Despite regulations, 'it's extremely easy to get it online in a few clicks,' says Dr Niall Campbell, addiction specialist and consultant at the Priory. Edibles, across the demographics, he says, are seen as ''acceptable'; it doesn't seem as harmful to be taking a colourful sweetie' when compared to smoking a joint.
While the absence of inhalation may improve the odds for lung-related issues, edibles are unregulated in the UK. With no standard level of THC content within each gummy – meaning some edibles might be far stronger than others – there is also 'no oversight of contaminants, and no reliable labelling,' says Dr Misra-Sharp. 'That makes dose titration [a technique used to determine the concentration of the chemicals] incredibly difficult and adds to the potential for harm' as users might not know how strong each edible is.
How do they affect the body?
Symptoms can include palpitations and tachycardia, sometimes mistaken for panic attacks; spikes in blood pressure or hypertension (which can elevate risk of heart attack, kidney disease and stroke); dizziness and chest pains, anxiety and insomnia (especially among those who use edibles before bed as a sleep aid).
Along with the UCSF research, cardiac issues have been repeatedly linked to regular marijuana use, including in a study of 435,000 adults published last year. Whether smoked, vaped or eaten, using the drug daily was connected to a 25 per cent higher risk of heart attack, and 42 per cent greater likelihood of stroke.
Dr Misra-Sharp adds that among her patients, dosing is a major issue when it comes to edibles, as they are so easy to over-consume. Many have displayed 'no real understanding of the dosing [or] onset time' – which can run into several hours, unlike the more immediate effects of smoking the drug.
The effects of edibles also typically last much longer. In some cases she has seen, patients have 'consumed multiple doses too quickly because they 'didn't feel anything', which has led to quite unpleasant episodes', such as 'intense anxiety, disorientation, vomiting, racing heart, and in some cases, temporary psychosis or paranoia'.
These can be exacerbated either by consuming edibles on an empty stomach, or as a result of THC being fat-soluble – leading to increased absorption when consumed via fatty foods, such as the sweets and cakes it is often contained in.
Another potential risk factor is how these edibles may adversely affect medication being taken for existing conditions – 'particularly in more vulnerable groups like older adults, or those taking medications such as beta-blockers, anticoagulants, or antidepressants'.
THC has been found to interact with close to 400 prescription medications, such as antidepressants and blood-thinners, while even taking CBD can affect more than 540 – something that is typically little understood by edible consumers.
Dr Misra-Sharp says: 'GPs need to start asking about cannabis use more routinely – not just smoking, but edibles too – and have honest, harm-reduction based conversations with our patients.'
How do they affect the brain?
While THC initially offers a dopamine high, over time, consumption can blunt the brain's reward systems, leading to a raised likelihood of depression, suicidal thoughts and mood swings. It can also impact the ability to form new memories, and hamper how information is processed.
Adolescent users may endure greater harm from edible overconsumption, as the brain continues to develop until we reach our mid-20s.
Dr Campbell says he has seen more people presenting with cannabis-induced mental health issues due to the seeming omnipresence of the drug. Multiple health services across the UK have linked the rise in patients dealing with psychosis to cannabis use, which they say accounts for around a quarter of all admissions; a Canadian study published earlier this year showed that growing potency of the drug had triggered a surge in cases of schizophrenia, too.
The only real way to prevent it taking a serious toll is 'stopping it, if it's not too late'. Sufferers can't work, they can't sustain a relationship, Dr Campbell explains. 'It can lead to violence, if you think someone's coming to get you. Patients flee imagined pursuers, jumping out of buildings and jumping in front of traffic as a result of paranoia. It means they're not productive members of society.'
Estimates have put the number of users affected by cannabis-induced paranoid delusions at 6 per cent – and it is the long-term damage that is particularly concerning, Dr Campbell says, due to the difficulty in treating the condition. Sufferers are poorly served by antipsychotic medication, he adds, citing one patient whose issues are 'kept at bay slightly by medication, but he's still paranoid and thinks everybody knows what he's thinking. That's a pretty sad, isolated kind of life.'
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